INSURANCE COVERAGE

CONTACT PATHWAY PLUS FOR SPECIFIC RESOURCES AND SERVICES

855-217-0698

INSURANCE COVERAGE

Coverage of nutritional products varies depending on many things including the type of insurance plan, the coverage policy, the care setting, the patient’s diagnosis, and the route of administration (oral or tube fed). Out-of-pocket costs such as deductibles, co-pays, and co-insurance also vary depending on the insurance plan. Select an insurance plan below to better understand their nutritional coverage policies.

MEDICARE

There are different types of Medicare plans. Medicare Part B is also known as Medicare Medical Insurance and helps cover healthcare providers’ services, outpatient care, some services provided by physical and occupational therapists and some preventive care services like medical nutrition therapy. In the homecare setting Medicare Part B provides coverage for enteral nutrition (liquid nutrition delivered through a feeding tube directly to the stomach or small intestine). In Skilled Nursing Facilities, tube-fed residents may have enteral nutrition covered by Medicare Part B after the Medicare Part A benefit limit has been reached.

MEDICARE FAQs

Q.

Does Medicare cover nutritional products?

A.

Medicare may cover nutritional products when they are fed through a feeding tube. Medicare does not cover products consumed orally (swallowing).

MEDICAID

Each state Medicaid program establishes its own criteria regarding coverage of nutritional products in the outpatient or homecare setting. Most state Medicaid programs will cover nutritional products when fed through a feeding tube, and many states will cover products consumed orally (swallowing) when specific criteria are met. Many people are enrolled in Medicaid managed care plans. Medicaid managed care provides Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs).

PRIVATE INSURANCE

Coverage varies by plan. Some insurance plans cover nutritional products when the patient’s health condition meets specific criteria. The healthcare provider must provide information supporting the diagnosis, condition, and medical necessity to justify the need for the product. Additionally, some states have insurance mandates that require certain payers to cover medical foods for certain conditions. These state mandates are all very different. To learn if your insurance plan covers nutritional products, call PATHWAY PLUS at 855-217-0698.

OTHER COVERAGE

MILITARY HEALTHCARE

TRICARE is the healthcare program serving uniformed service members, retirees and their families. Abbott Nutrition products may be reimbursed through TRICARE on the basis of medical need when ordered by a healthcare provider.

View the website below for more information about TRICARE's coverage policy of nutritional therapy.

SUPPLEMENT NUTRITION ASSISTANCE PROGRAM

The Supplemental Nutrition Assistance Program (SNAP) (formerly Food Stamps) helps low-income people and families buy the food they need for good health. Most Abbott Nutrition products are available for purchase using SNAP benefits.

View the website below for information regarding SNAP.

THE SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC)

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. WIC provides infant formula for babies who are not exclusively breastfed and provides many specialized formulas for infants, women, and children with appropriate medical documentation. Check with your local or state WIC agency to see which Abbott products are available in your state.

View the website below for information regarding WIC.

Disclaimer:
Each healthcare provider is ultimately responsible for verifying codes, coverage, and payment policies used to ensure that they are accurate for the services and items provided. Providers should consult with the insurance plan for complete and accurate details concerning documentation for claims. Abbott Nutrition does not guarantee reimbursement by any third-party insurance plan and will not reimburse physicians or providers for claims denied by third-party insurance plans.